Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results

• Published in: The American heart journal Vol. 130; no. 6; pp. 1250 - 1253
• Main Authors: Mahanonda, Nithi, Bhuripanyo, Kiertijai, Kangkagate, Charuwan, Wansanit, Kanchana, Kulchot, Bang-on, Nademanee, Koonlawee, Chaithiraphan, Suphachai
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.1995; Elsevier
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Atenolol - therapeutic use; Biological and medical sciences; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Double-Blind Method; Female; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Syncope - drug therapy; Tilt-Table Test; Treatment Outcome; Human; Nervous system diseases; Consciousness impairment; Diseases of the autonomic nervous system; Controlled therapeutic trial; Neurological disorder; Vasovagal syncope; Tilt table; Beta blocking agent
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(95)90150-7

The objective of this investigation was the assessment of the response rate of oral atenolol in patients with vasovagal syncope after 1 month of treatment. We randomized into two groups all patients referred to our unit who had had at least one episode of syncope or two episodes of presyncope 1 month before presentation and had a positive isuprel Tilt Table Test (TTT). Group 1 (Gr 1) received oral atenolol, and group 2 (Gr 2) received placebo medication. After a 1-month period patients were reassessed for degree of their symptoms and underwent repeated TTT. Forty-two patients were enrolled in the study. Gr 1 and Gr 2 were comparable in age (38 ± 13 years vs 43 ± 14 years, p = 0.216 and sex (male/female = 6:15 vs 10:11, p = 0.204). The severity of attack was similar in both groups. Eight patients in Gr 1 and six patients in Gr 2 had mitral valve prolapse (p = 0.5). No significant differences were seen in systolic blood pressure (122 ± 17 vs 117 ± 16 mm Hg, p = 0.334), diastolic blood pressure (70 ± 11 vs 72 ± 11 mm Hg, p = 0.677), and heart rate (79 ± 12 vs 79 ± 13, p = 0.98) between the two groups. The response rates (negative TTT) after 1 month of treatment were 62% versus 5% (p = 0.0004) in the atenolol and control group, respectively. Moreover, patients who received atenolol reported feeling better compared with those who received placebo (71% vs 29%, p = 0.02). In conclusion, atenolol significantly improved symptoms of patients with vasovagal syncope. Patients who received atenolol were more likely to have negative isuprel TTT.